Abstract

In 1984 the English National Board (the newly appointed controlling body for nurse education in England) invited schools of nursing to submit innovatory and progressive programmes for nurse education. Basis for selection was the capacity of the programmes to begin to address the demands for a new type of nursing practitioner. The programmes were to be aimed at providing an education that would enable the nurse of the future to adapt to the changing needs created by an increasingly dynamic nursing profession. It was proposed that the selected programmes would act as forerunners for new educational initiatives and facilitate the transition to a more clearly oriented nursing approach.

The longitudinal study was designed to evaluate the effectiveness of one of the selected pilot educational programmes. It was premised on the assumption that traditional hierarchical nurse educational approaches may affect student self esteem and in consequence the ability of the qualified nurse to achieve the self confidence required for independent professional practice and self-growth. It rests on the argument that a positive self image and external locus of control allows nurses to become self assertive, confident and dynamic practitioners capable of embracing and initiating change in response to predicted continuing change in psycho-social health demands.

The innovations introduced in the pilot scheme included the adoption of a humanistic, student centred, adult educational model of teaching/ learning approach that focuses on promoting self worth in its learners. This led to the study proposal that the effectiveness of the course can be evaluated by focusing on whether the educational changes eliminate the potentially destructive effects of earlier courses on nursing students by enhancing their self concept to the benefit of their self confidence in practice during supervised training and after qualifying. The study draws on the theories of the Self, on Attribution Theory. Social Learning Theory and in particular Adult Educational Theory with its focus on recognition of self-worth. It utilises an eclectic illuminative evaluation method that encompasses a balance between quantitative measurement and qualitative information. The results of measurements taken of students values and perceptions of themselves and their chosen profession on entry and at differing stages of the course. Are recorded together with further measurements undertaken by a sample of course graduates after a period of practice. Methods included the use of self designed and standardised instruments and individual and group interview techniques. The descriptive study also explores and compares the demographic characteristics, values, expectations and learning preferences particularly in relation to developing qualities of learner independence and student directedness. An overall participative approach takes into account the varying information needs of its diverse potential audience.

The study design recognised the importance of ensuring that the evaluation had a formative component to allow it to offer an improvement function to the quality of study of the students who participated in the various evaluation measures during their own educational process. The findings demonstrated that the programme was successful in achieving its aims. But post course enquiries into the course graduates initial staff nurse experiences, revealed a marked fall in self confidence when they were first confronted with responsibility and accountability. The high anxiety levels, and fears of 'not knowing' how to carry out more complex procedures led to the recommendation that the initial period of preceptorship should include a supernumerary interval in which the newlv qualified staff nurse could be free to 'catch up' on experiences not encountered during the clinical allocations.

It is envisaged that the findings will be of interest to the wider nurse educational arena at both local and national level. It will assist not only nurse education programme planners and those implementing the Project 2000 initiatives but also educationalists in compulsory, further and higher education. Finally as a direct record of the effects of the most fundamental changes in nursing history, it has the potential for becoming a source document for future nurse historians.